An 8-week course of St. John's wort did not improve
attention-deficit/hyperactivity disorder symptoms in what researchers
described as the first-ever randomized clinical trial of the herbal
remedy in children and adolescents, according to a report in JAMA.

Compared with placebo, St. John's wort--one of the three most
common herbal treatments for ADHD in the pediatric population--did not
improve hyperactivity, impulsivity, or inattentiveness, reported Wendy
Weber, Ph.D., of Bastyr University's School of Naturopathic
Medicine, Kenmore, Wash., and her associates.

As many as 30% of children with ADHD fail to respond to, or cannot
tolerate, pharmaceutical medicine for the disorder, so many parents turn
to complementary or alternative medicines. St. John's wort
(Hypericum perforatum) has been found to inhibit the reuptake of
norepinephrine, so in theory it might be beneficial in ADHD.

Dr. Weber and her associates studied 54 healthy subjects aged 6-17
years who met DSM-IV criteria for ADHD based on structured diagnostic
interviews. Half the subjects were randomly assigned to take a 300-mg
capsule of St. John's wort, and the other half were to take placebo
capsules, three times daily (before school, after school, and before
bed), for 8 weeks. ADHD symptoms were assessed at office visits at
baseline and every 2 weeks thereafter using the ADHD Rating Scale-IV, an
18-item standardized instrument for weekly assessment of treatment
response. The Clinical Global Impression Improvement Scale also was used
at weeks 4 and 8 to evaluate whether global impairment worsened,
remained steady, or improved.

The treatment's potential effect on other behavioral problems
was assessed using the Child Behavior Checklist and Youth Self Report
Form. Parents also reported their assessments of ADHD symptoms by
completing the Con-ners' Parent Rating Scale at baseline and at the
conclusion of the study.

Finally, changes in quality of life were evaluated using the PedsQL
form.

Possible adverse effects were tracked using a measure of 76
potential adverse effects. There were no significant differences between
the two groups in ADHD symptoms on any assessment, either in the
intention-to-treat analysis or the per-protocol analysis, Dr. Weber and
her associates said (JAMA 2008;299:2633-41).

The subset of children who had never taken pharmaceutical
medication for ADHD before this study also showed no improvement beyond
that achieved with placebo, the investigators added.

The study was supported by grants from the National Center for
Complementary and Alternative Medicine, an agency of the National
Institutes of Health. Dr. Weber reported no conflicts of interest.

BY MARY ANN MOON

Contributing Writer

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